Surveillance of hemorrhagic fever and/or neuroinvasive disease: challenges of diagnosis

• Published in: Revista de saúde pública Vol. 55; p. 41
• Main Authors: Araújo, Leonardo José Tadeu de, Gonzalez, Lorenzo Lang, Buss, Lewis Fletcher, Guerra, Juliana Mariotti, Gomez, David Salas, Ferreira, Camila Santos da Silva, Cirqueira, Cinthya Santos, Ghillardi, Fábio, Witkin, Steven S., Sabino, Ester Cerdeira
• Format: Journal Article
• Language: English; Portuguese
• Published: Faculdade de Saúde Pública da Universidade de São Paulo 01.01.2021; Universidade de São Paulo
• Subjects: Autopsy. Hemorrhagic Fevers; etiology. Arbovirus Infections; Health Policy & Services; mortality; Original; Viral; mortality; etiology. Arbovirus Infections; Autopsy. Hemorrhagic Fevers; Viral
• ISSN: 0034-8910; 1518-8787; 1518-8787
• DOI: 10.11606/s1518-8787.2021055003068

  OBJECTIVE To evaluate the performance of post mortem laboratory analysis in identifying the causes of hemorrhagic fever and/or neuroinvasive disease in deaths by arbovirus infection. METHODS Retrospective cross-sectional study based on the differential analysis and final outcome obtained in patients whose samples underwent laboratory testing for arboviruses at the Pathology Center of the Adolfo Lutz Institute, in São Paulo, Brazil. RESULTS Of the 1355 adults clinically diagnosed with hemorrhagic fever and/or neuroinvasive disease, the most commonly attributed cause of death and the most common final outcome was dengue fever. Almost half of the samples tested negative on all laboratory tests conducted. CONCLUSION The failure to identify the causative agent in a great number of cases highlights a gap in the diagnosis of deaths of unknown etiology. Additional immunohistochemical and molecular assessments need to be added to the post-mortem protocol if all laboratory evaluations performed fail to identify a causative agent. While part of our findings may be due to technical issues related to sample fixation, better information availability when making the initial diagnosis is crucial. Including molecular approaches might lead to a significant advancement in diagnostic accuracy.